Tuberculosis -- United States, 1982

In 1982, 25,520 cases of tuberculosis (TB) were reported to
CDC,
for a case rate of 11.0 per 100,000 population. Compared with
1981,
this represents a 6.8% decrease in the number of cases reported and
a
decline of 7.6% in the case rate (Table 1).

Rates for the 50 states ranged from 25.4/100,000 in Hawaii to
2.0/100,000 in Wyoming. The rate increased in 13 states, remained
unchanged in two, and decreased in 35 states and the District of
Columbia (Figure 2). The rate among persons living in 56 cities of
more than 250,000 population was 22.1/100,000--twice the national
rate
and 5.6% less than the rate for the same cities in 1981. Urban
rates
ranged from 61.4/100,000 in Miami, Florida, to 3.8/100,000 in
Omaha,
Nebraska. The rate increased in 21 of the country's 56 largest
cities. Eight cities had rates at least three times the national
rate: Miami, Florida; Newark, New Jersey; San Francisco,
California;
Houston, Texas; Atlanta-Fulton County, Georgia; Washington, D.C.;
Chicago, Illinois; and Honolulu, Hawaii.

Of the 25,520 TB cases reported in 1982, Mycobacterium
tuberculosis was isolated in 19,050. The proportion of
culture-positive cases increased from 70.5% of total cases in 1981
to
74.6% in 1982.
Reported by Div of Tuberculosis Control, Center for Prevention
Svcs,
CDC.

Editorial Note

Editorial Note: From 1968 through 1978, the average annual
decrease
in TB cases in the United States was 5.6%. From 1979 through 1981,
when there was a large influx of Southeast Asian refugees, the
average
annual decline was only 1.4%. The 6.8% decrease in the number of
cases in 1982 may indicate that the previous downward trend has
resumed. This may be explained in part by the smaller number of
refugee arrivals in 1982. Another factor that may have influenced
the
reported morbidity figures for 1982 is the implementation of a new
individual case-reporting system that requires more accurate
verification of cases before they are counted. In January 1982, 20
additional areas began using the new system, which is being phased
in
over several years.

Despite the decline in the number of cases reported in 1982, TB
persists as a public health problem. Transmission of infection
continues, as evidenced by the continued occurrence of disease in
young children. It is estimated that more than 10 million persons
in
this country are infected with tubercle bacilli. They have a
lifelong
risk of developing disease, unless given preventive treatment.
Cases
will continue to occur in this group for years to come, and
additional
cases will occur in new residents of this country who come from
areas
of the world where TB incidence and infection rates are much higher
than in the United States.

State and local health departments are responsible for ensuring
the control of TB at the community level. Currently, 40,000-45,000
persons on health department registers require treatment and
follow-up
for TB. Each year, over 200,000 persons exposed to new cases must
be
examined, and many of these should receive preventive treatment.
TB
control has been complicated by the global emergence of organisms
resistant to antituberculosis drugs, and community outbreaks of
drug-resistant disease continue to occur in the United States.

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